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Figure. A, Baseline medical problems that required a visit (A) and the acute medical reason for a visit (B) to a satellite clinic during days 3 to 6.

Figure. A, Baseline medical problems that required a visit (A) and the acute medical reason for a visit (B) to a satellite clinic during days 3 to 6.

1.
Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL. Communicable diseases in complex emergencies: impact and challenges.  Lancet. 2004;364(9449):1974-1983PubMedArticle
2.
Wilder-Smith A. Tsunami in South Asia: what is the risk of post-disaster infectious disease outbreaks?  Ann Acad Med Singapore. 2005;34(10):625-631PubMed
Research Letters
Feb 13, 2012

Necessity for Primary Care Immediately After the March 11 Tsunami and Earthquake in Japan

Author Affiliations

Author Affiliations: Divisions of Cardiology (Drs Kohsaka, Endo, Ueda, and Fukuda) and Emergency Medicine (Dr Namiki), Keio University School of Medicine, Tokyo, Japan.

Arch Intern Med. 2012;172(3):290-291. doi:10.1001/archinternmed.2011.1387

On March 11, 2011, Japan was devastated by a massive magnitude 9.0 earthquake and tsunami. Immediately after the earthquake, the rescue of injured people was the most urgent task. However, a critical feature of this tragedy was that because the chances to carry out emergency medical care were scarce, there was a clear division between those who died in the tsunami and those who were spared. Most of the survivors were sheltered in schools, gymnasiums, and regional resource centers during the cold season in northern Japan, and the effort of voluntary medical staff after the tsunami was largely focused on providing usual care with extremely limited medical resources. We sought to describe the characteristics of medical care in an evacuation shelter during the subacute phase of the March 11 tsunami disaster.

Method

We collected the medical information from tentative medical charts that were recorded in a single large evacuation shelter at Kesenuma City in Miyagi Prefecture. The K-wave gymnasium (Miyagi, Japan) sheltered approximately 1500 survivors who lost their home after the tsunami. A temporary medical clinic was established on day 3 after the tsunami, and 2 to 3 physicians along with 3 to 5 nurses and pharmacists ran the clinic from 9 AM to 5 PM daily. From the medical charts, patients' characteristics and the dispensed drugs were recorded. Of note, owing to the lack of gasoline during the acute phase of this disaster, transportation to medical care facilities was extremely limited and the closest hospital from the shelter was more than 1 hour away by car.

Results

Most of the patients who visited the temporary clinic in the shelter had baseline chronic disorders and lacked access to medications, including prescriptions and drug supplies, and had a need for nonmedical personnel after the acute phase. Their baseline disorders included hypertension, diabetes, peripheral vascular diseases, and neurological problems (Figure, A). Another aspect of the defining characteristics was the large number of elderly victims; 59.6% of the patients were older than 65 years. Those who came to temporary clinic with new complaints had mostly gastrointestinal and pain-related issues. The number of patients with infective symptoms exponentially increased on day 6 (Figure, B). The crowded and cold environment in gymnasiums with minimum sewerage systems likely led to spreading infectious diseases including influenza, streptococcal pneumonia, and viral diarrhea.1,2 Consequently, among all the drugs, the dispensation rate was relatively high for common cold relief. Also, many antihypertensive drugs were given to patients with underlying hypertension.

Comment

Unlike the previous catastrophic events worldwide, the need for a primary care system rather than disaster specialists was high immediately after the March 11 tsunami and earthquake. Most of the medical care that was provided in shelters were gastrointestinal, chronic pain, and later, infection related. More importantly, continuity of previous medical care was an essential part of these satellite clinics.

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Article Information

Correspondence: Dr Kohsaka, Division of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan 160-0016 (cardiotx@gmail.com).

Author Contributions:Study concept and design: Kohsaka, Namiki, and Fukuda. Acquisition of data: Kohsaka and Namiki. Analysis and interpretation of data: Kohsaka, Endo, Ueda, and Namiki. Drafting of the manuscript: Kohsaka and Endo. Critical revision of the manuscript for important intellectual content: Kohsaka, Ueda, Namiki, and Fukuda. Statistical analysis: Kohsaka, Endo, and Ueda. Administrative, technical, and material support: Fukuda. Study supervision: Kohsaka and Namiki.

Financial Disclosure: None reported.

References
1.
Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL. Communicable diseases in complex emergencies: impact and challenges.  Lancet. 2004;364(9449):1974-1983PubMedArticle
2.
Wilder-Smith A. Tsunami in South Asia: what is the risk of post-disaster infectious disease outbreaks?  Ann Acad Med Singapore. 2005;34(10):625-631PubMed
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